• J. Cardiothorac. Vasc. Anesth. · Sep 2023

    Observational Study

    Association Between Risk of Stroke and Delirium After Cardiac Surgery and a New Electroencephalogram Index of Interhemispheric Similarity.

    • Baron ShahafDanaDDepartment of Anesthesia, Rambam Health Care Campus, Haifa, Israel. Electronic address: dana_bs@rambam.health.gov.il., Darren Hight, Heiko Kaiser, and Goded Shahaf.
    • Department of Anesthesia, Rambam Health Care Campus, Haifa, Israel. Electronic address: dana_bs@rambam.health.gov.il.
    • J. Cardiothorac. Vasc. Anesth. 2023 Sep 1; 37 (9): 169116991691-1699.

    ObjectivesNeurologic complications after surgery (stroke, delirium) remain a major concern despite advancements in surgical and anesthetic techniques. The authors aimed to evaluate whether a novel index of interhemispheric similarity, the lateral interconnection ratio (LIR), between 2 prefrontal electroencephalogram (EEG) channels could be associated with stroke and delirium following cardiac surgery.DesignRetrospective observational study.SettingSingle university hospital.ParticipantsA total of 803 adult patients without documentation of a previous stroke, who underwent cardiac surgery with cardiopulmonary bypass (CPB) between July 2016 and January 2018.InterventionsThe LIR index was calculated retrospectively from the patients' EEG database.Measurements And Main ResultsLIR was analyzed intraoperatively every 10 seconds and compared among patients with postoperative stroke, patients with delirium, and patients without documented neurologic complications, during 5 key periods, each lasting10 minutes: (1) surgery start, (2) before CPB, (3) on CPB, (4) after CPB, and (5) surgery end. After cardiac surgery, 31 patients suffered from stroke; 48 patients were diagnosed with delirium; and 724 had no documented neurologic complications. Patients with stroke demonstrated a decrease in LIR index between the start of surgery and the postbypass period of 0.08 (0.01, 0.36 [21]; median and [interquartile range {IQR}]; valid EEG samples); whereas there was no similar decrease in the no-dysfunction group (-0.04 [-0.13, 0.04; {551}], p < 0.0001). Patients with delirium showed a decrease in LIR index between the start of surgery and the end of the surgery by 0.15 (0.02, 0.30 [12]), compared with no such decrease in the no-dysfunction group (-0.02 [-0.12, 0.08 {376}], p ≈ 0.001).ConclusionsAfter improvement of SNR, it might be of value to further study the index decrease as an indication for risk for brain injury after surgery. The timing of decrease (after CPB or end of surgery) may provide hints regarding the injury pathophysiology and its onset.Copyright © 2023 Elsevier Inc. All rights reserved.

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